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ENGLISH ABSTRACT
术前超声引导FNA联合FNA-Tg测定诊断PTC颈部淋巴结转移的价值
申学舟
陈利民
贺军
柳刚
项延包
黄晓萍
作者及单位信息
·
DOI： 10.3760/cma.j.cn341190-20240715-00906
Value of preoperative ultrasound-guided fine-needle aspiration of lymph nodes combined with washout thyroglobulin testing in diagnosing lymph node metastasis in papillary thyroid carcinoma
Shen Xuezhou
Chen Limin
He Jun
Liu Gang
Xiang Yanbao
Huang Xiaoping
Authors Info & Affiliations
Shen Xuezhou
Department of Ultrasound, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China
Chen Limin
Department of Ultrasound, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China
He Jun
Department of Ultrasound, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China
Liu Gang
Department of Ultrasound, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China
Xiang Yanbao
Clinical Laboratory, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China
Huang Xiaoping
Department of Pathology, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China
·
DOI： 10.3760/cma.j.cn341190-20240715-00906
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摘要

目的评价术前淋巴结细针穿刺（FNA）联合穿刺洗脱液甲状腺球蛋白（FNA-Tg）检测在甲状腺乳头状癌（PTC）颈部淋巴结转移的诊断价值。

方法选取2021年12月至2023年12月在温州市中心医院确诊患PTC且术前超声发现可疑侧颈部淋巴结转移的112例患者进行前瞻性研究，所有患者均接受淋巴结FNA和FNA-Tg，所有可疑淋巴结被手术摘除，对比分析FNA、FNA-Tg及FNA+FNA-Tg诊断PTC伴淋巴结转移的效能。

结果112例患者检出120个淋巴结，其中98例淋巴结被病理证实发生转移。FNA细胞学检查结果83例为阳性，37例为阴性；侧颈部淋巴结转移诊断的准确度、灵敏度和特异度分别达到了80.83%，80.61%和81.82%。洗脱液FNA-Tg检测中，89例为阳性，31例为阴性；侧颈部淋巴结转移诊断的准确度、灵敏度和特异度分别达到了89.17%，88.78%和90.91%。FNA+FNA-Tg联合使用时，判定阳性有101例，阴性有19例；侧颈部淋巴结转移诊断的准确度、灵敏度和特异度分别为94.17%、97.96%、77.27%。采用FNA+FNA-Tg方法，较FNA、FNA-Tg，其在诊断PTC转移性颈部侧淋巴结方面展现出更高的准确性，其差异均有统计学意义（ χ 2=50.64， P < 0.001； χ 2=64.81， P < 0.001）。

结论联合FNA+FNA-Tg诊断PTC颈侧淋巴结转移的具有较高的准确性。

甲状腺肿瘤;活组织检查，细针;甲状腺球蛋白;淋巴转移;手术前期间
ABSTRACT

ObjectiveTo investigate the diagnostic value of preoperative fine-needle aspiration (FNA) of lymph nodes combined with washout thyroglobulin testing (FNA-Tg) for detecting lymph node metastasis in papillary thyroid carcinoma (PTC).

MethodsA prospective study was conducted on 112 patients diagnosed with PTC at Wenzhou Central Hospital from December 2021 to December 2023, all of whom had suspicious lateral cervical lymph node metastasis identified through preoperative ultrasound. All patients underwent lymph node FNA and FNA-Tg. The suspicious lymph nodes were surgically excised. The diagnostic efficacy of FNA, FNA-Tg, and the combination of FNA and FNA-Tg for PTC with lymph node metastasis was compared.

ResultsA total of 112 patients were identified with 120 lymph nodes, among which 98 lymph nodes were confirmed to have metastasis by pathology. The results of the FNA cytology examination revealed 83 positive cases and 37 negative cases. The accuracy, sensitivity, and specificity for diagnosing lateral cervical lymph node metastasis were 80.83%, 80.61%, and 81.82%, respectively. In the FNA-Tg, there were 89 positive cases and 31 negative cases, with accuracy, sensitivity, and specificity for diagnosing lateral cervical lymph node metastasis at 89.17%, 88.78%, and 90.91%, respectively. When FNA and FNA-Tg were used in combination, there were 101 positive cases and 19 negative cases; the accuracy, sensitivity, and specificity for diagnosing lateral cervical lymph node metastasis were 94.17%, 97.96%, and 77.27%, respectively. The combined use of FNA and FNA-Tg demonstrated significantly higher accuracy in diagnosing metastatic lateral cervical lymph nodes in PTC compared to FNA and FNA-Tg alone ( χ 2 = 50.64, P < 0.001; χ 2 = 64.81, P < 0.001).

ConclusionsThe combined use of FNA and FNA-Tg demonstrates high accuracy in diagnosing lateral cervical lymph node metastasis in PTC.

Thyroid neoplasms;Biopsy, fine-needle;Thyroglobulin;Lymphatic metastasis;Preoperative period
Chen Limin, Email: mocdef.3ab61drawohmlc
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申学舟,陈利民,贺军,等. 术前超声引导FNA联合FNA-Tg测定诊断PTC颈部淋巴结转移的价值[J]. 中国基层医药,2025,32(03)：342-346.

DOI:10.3760/cma.j.cn341190-20240715-00906

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甲状腺乳头状癌（papillary thyroid carcinoma，PTC）是分化型甲状腺癌中最为常见的亚型，其在所有甲状腺癌病例中的占有较高比例 ［ 1 ］ ，PTC早期发生颈部淋巴结转移比例达50% ［ 2 , 3 , 4 ］ 。对于分化良好的甲状腺癌患者，颈部淋巴结的治疗性清扫术已达成共识：cN1类别的患者应当进行该手术；而对于预防性侧颈部淋巴结清扫手术，则并不推荐进行 ［ 5 ］ 。基于此，术前对颈部淋巴结进行精确的评估，对于确立适宜的治疗计划及手术方式具有重要意义。目前，对于诊断PTC转移性淋巴结，主要采用的方法包括高频超声检查、颈部计算机断层扫描（CT）、颈部磁共振成像（MRI）以及颈部淋巴结细针抽吸（fine needle aspiration，FNA）细胞学检查等技术。在这些方法中，FNA在准确度方面相较于其他手段表现更为优异。然而，此项技术的准确度受到执行者经验、涂片技术等多种因素的影响，影响侧颈部淋巴结转移的诊断 ［ 6 , 7 ］ 。细针穿刺洗脱液中测定甲状腺球蛋白（washout fluid thyroglobulin in fine needle aspiration，FNA-Tg）技术，作为一种较为先进的诊断方法，已被众多研究验证，能够显著提升在PTC转移性颈部淋巴结诊断中的灵敏度 ［ 8 , 9 , 10 ］ ，可以作为FNA诊断PTC淋巴结转移的有效补充手段。本研究采取了超声引导下的FNA与FNA-Tg测定双重方法，旨在探讨其在PTC转移性侧颈部淋巴结术前诊断中的效能，以辅助临床医师做出合适的手术方式的决策。
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备注信息
A
陈利民，Email： mocdef.3ab61drawohmlc
B

申学舟：采集数据、起草文章；贺军、柳刚、项延包、黄晓萍：统计分析、技术支持；申学舟、陈利民：设计试验、起草文章

C
申学舟, 陈利民, 贺军, 等. 术前超声引导FNA联合FNA-Tg测定诊断PTC颈部淋巴结转移的价值[J]. 中国基层医药,2025,32(3):342-346. DOI:10.3760/cma.j.cn341190-20240715-00906.
D
所有作者声明不存在利益冲突
E
浙江省温州市科技局科技项目 (Y20211043)
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